C-reactive protein and microalbuminuria differ in their associations with various domains of vascular disease

Stuveling, Erik M.; Hillege, Hans L.; Bakker, Stephan J. L.; Asselbergs, Folkert W.; Jong, Paul E. de; Gans, Rijk O. B.; Zeeuw, Dick de

doi:10.1016/s0021-9150(03)00252-1

Cited by 49 publications

(25 citation statements)

References 32 publications

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“…As a third possibility, urine albumin and CRP might represent unrelated variables sensitive to different aspects of a common pathological stimulus such as subclinical vascular damage. Previous data have shown a preferential affinity of MA and CRP for various domains of vascular disease 26 or different degrees of vascular dysfunction, low-grade inflammation being preferentially associated with abnormal endothelial-dependent 27 and MA also to endothelial-independent 28 vasomotor responses. That hypothesis is consistent with the higher rates of inflammatory MA reported in presence of disparate clinical conditions characterized by increased cardiovascular risk and widespread vascular dysfunction such as severe hypertension, 29 obesity, 30 and MS. 31 Some short comment also deserves the presence of MA and low hs-CRP levels in patients characterized by leaner body size, lower BP, and a better metabolic and cardiovascular profile than those sharing elevated UAE but higher CRP levels, a contrast suggestive of different pathophysiological determinants to the genesis of hypertensive MA.…”

Section: Discussionmentioning

confidence: 90%

Low-Grade Inflammation and Microalbuminuria in Hypertension

Pedrinelli

Dell’Omo

Bello

et al. 2004

ATVB

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Background-Albuminuria and C-reactive protein (CRP), a marker of systemic low-grade inflammation, are frequently elevated in essential hypertension and predict cardiovascular prognosis independent of conventional risk factors. However, in spite of their potentially important links, the interrelationships between the 2 parameters have not been explored in depth in hypertensive patients. Methods and Results-Albuminuria (the mean of 3 overnight urine collections), high-sensitive CRP (hs-CRP), 24-hour blood pressure (BP), weight, lipids, poststimulative (75 g PO) plasma glucose, insulin, and insulin sensitivity by the homeostasis model assessment model were evaluated in 220 never treated, nondiabetic, uncomplicated essential hypertensive men. Albuminuria Ն15 g/min was defined as microalbuminuria and hs-CRP values above and below median (2.3 mg/L) as high and low, respectively. Concentric left ventricular hypertrophy was diagnosed by echocardiography, and a full-blown metabolic syndrome was identified in presence of hypertension and at least 3 of following: obesity, subclinical hyperglycemia, low high-density lipoprotein (HDL) and high triglycerides. Microalbuminuria was present in 54 patients, 29 with high hs-CRP characterized by higher 24-hour systolic BP, postload glucose, body mass index, lower HDL cholesterol, more frequent metabolic syndrome, concentric LVH, and active smoking than those with either isolated microalbuminuria (nϭ27) or normoalbuminuria. Conclusions-Microalbuminuria accompanied by evidence of subclinical inflammation is a strong correlate of metabolic abnormalities in essential hypertension and identifies a patient subset at very high cardiovascular risk. In contrast, isolated microalbuminuria may represent a distinct pathophysiological condition characterized by a more benign profile and possibly a better prognosis.

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Section: Discussionmentioning

confidence: 90%

Low-Grade Inflammation and Microalbuminuria in Hypertension

Pedrinelli

Dell’Omo

Bello

et al. 2004

ATVB

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“…Third, impaired kidney function may be a marker merely for severity of vascular disease, including atherosclerosis that is not yet clinically evident (62,71). Finally, impaired kidney function is associated with markers of inflammation and other putative risk factors for cardiovascular events (72)(73)(74)(75), which might contribute directly to adverse outcomes.…”

Section: Discussionmentioning

confidence: 99%

Chronic Kidney Disease and Mortality Risk

Tonelli

Wiebe²,

Culleton³

et al. 2006

Journal of the American Society of Nephrology

1,439

978

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Current guidelines identify people with chronic kidney disease (CKD) as being at high risk for cardiovascular and all-cause mortality. Because as many as 19 million Americans may have CKD, a comprehensive summary of this risk would be potentially useful for planning public health policy. A systematic review of the association between non-dialysis-dependent CKD and the risk for all-cause and cardiovascular mortality was conducted. Patient-and study-related characteristics that influenced the magnitude of these associations also were investigated. MEDLINE and EMBASE databases were searched, and reference lists through December 2004 were consulted. Authors of 10 primary studies provided additional data. Cohort studies or cohort analyses of randomized, controlled trials that compared mortality between those with and without chronically reduced kidney function were included. Studies were excluded from review when participants were followed for <1 yr or had ESRD. Two reviewers independently extracted data on study setting, quality, participant and renal function characteristics, and outcomes. Thirty-nine studies that followed a total of 1,371,990 participants were reviewed. The unadjusted relative risk for mortality in participants with reduced kidney function compared with those without ranged from 0.94 to 5.0 and was significantly more than 1.0 in 93% of cohorts. Among the 16 studies that provided suitable data, the absolute risk for death increased exponentially with decreasing renal function. Fourteen cohorts described the risk for mortality from reduced kidney function, after adjustment for other established risk factors. Although adjusted relative hazards were consistently lower than unadjusted relative risks (median reduction 17%), they remained significantly more than 1.0 in 71% of cohorts. This review supports current guidelines that identify individuals with CKD as being at high risk for cardiovascular mortality. Determining which interventions best offset this risk remains a health priority. I t has been known for many years that ESRD is associated with very high mortality and accelerated cardiovascular disease (1). Several recent studies suggest that the risk for death is increased independently in individuals who have less severe impairment of kidney function and are not dialysis dependent, compared with those who have preserved kidney function (2,3). However, other rigorously conducted studies have found little or no significant increase in all-cause or cardiovascular mortality in the setting of mild to moderate chronic kidney disease (CKD) (4,5). Even among studies that have demonstrated higher mortality rates in people with CKD, the magnitude of the increased risk has varied substantially for reasons that are unclear.Current guidelines identify individuals with CKD as being at high risk for cardiovascular disease and other adverse outcomes (6). Because non-dialysis-dependent CKD may affect as many as 19 million Americans (7), a summary of the risk for all-cause and cardiovascular mortality associated w...

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“…Venous blood was drawn into EDTA tubes; aliquots were made and stored at\ \80°C until analysis. The biomarkers tested were high-sensitive troponin-T (hs-TnT) [12], N-terminal pro-B-type natriuretic peptide (NT-proBNP) [13], mid-regional pro-A-type natriuretic peptide (MR-proANP) [14], C-terminal pro-endothelin-1 (CT-proET-1) [15], renin [9], aldosterone [9], C-terminal pro-arginine vasopressin (copeptin) [16], mid-regional pro-adrenomedullin (MR-proADM) [17], high-sensitive C-reactive protein (hs-CRP) [18], procalcitonin [19], plasminogen activator inhibitor-1 (PAI-1) [20], galectin-3 [21], urinary albumin excretion (UAE) [22], serum creatinine [17] and cystatin-C [17]. Details of the assays can be found in the data supplement.…”

Section: Methodsmentioning

confidence: 99%